Healthcare Provider Details

I. General information

NPI: 1437572658
Provider Name (Legal Business Name): LYRON DIAGNOSTIC CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19100 SW 177TH AVE STE 3
MIAMI FL
33187-2021
US

IV. Provider business mailing address

19100 SW 177TH AVE STE 3
MIAMI FL
33187-2021
US

V. Phone/Fax

Practice location:
  • Phone: 305-964-7618
  • Fax: 786-732-0473
Mailing address:
  • Phone: 305-964-7618
  • Fax: 786-732-0473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberME105585
License Number StateFL

VIII. Authorized Official

Name: LIRON BELTZER
Title or Position: PRESIDENT
Credential: MD
Phone: 305-964-7618